Perimenopause Frequently Asked Questions

In general, it is important to do 'one at a time' when trying out medications or any intervention for a symptom or a problem. If you decide to take both drugs, I would try one for at least a month before adding the other.

4. I have not had a period in several months. Will starting progesterone bring my periods back?

Good question! Whether or not progesterone will 'cause' flow in perimenopause is totally dependent on whether estrogen has been present to stimulate the lining of the uterus to thicken or proliferate. Therefore, it is possible that taking progesterone may bring back flow, however, it can be expected that flow will be lighter. Keep in mind that having this flow has the positive aspect of preventing endometrial hyperplasia (thickening of the lining of the uterus) which can be a precursor to cancer.

Nausea is caused by high estrogen levels that are often present in perimenopause. For some women, for reasons that are not entirely clear, nausea is worse in the first few days after starting progesterone. This subsides within a week or so. I don't believe it is the progesterone that is causing the nausea but rather some cross-talk with our own high estrogen levels.

Estrogen is a very powerful growth stimulator of cells and thus is important for the health of both men and women. In addition, it indirectly holds bone resorption (removal of old bone) in check to prevent excess bone loss. Estrogen plays positive roles in most tissues but if its growth stimulation is not held in check, it can promote cells to transform into cancer and also stimulate cancer growth.

Progesterone (pro=for, gest=pregnancy) is absolutely essential for becoming pregnant and for maintaining that pregnancy to full term. Progesterone also acts in the breasts, brain, bones, skin and every organ and tissues of women's bodies. Progesterone, like estrogen, stimulates cells to grow and multiply but only for about three days – longer durations of progesterone cause cells to become more mature. Progesterone then stops cell overgrowth thus it would decrease cancer risk. For example, for bone health in menstruating women, menstrual cycles need to be of normal length (about 3 – 5 weeks apart) and regular to make enough estrogen, allow ovulation and make enough progesterone for at least 10 – 12 days. Estrogen stops excess bone loss and progesterone promotes formation of new bone (by stimulating bone forming cells called osteoblasts.)

Progesterone does not cause weight gain. Progesterone does not increase facial hair. Both weight gain and increased facial hair are things that may occur when taking synthetic progesterone-like drugs that are properly called "progestins" but are sometimes mistakenly called "progesterone" even in medical publications and by doctors.

About weight gain

If anything, natural progesterone will help with weight loss. Why do I say that? First because progesterone makes us burn about 300 more calories (kCal) a day because it raises our core temperature about 0.2 degrees C. and that requires energy. (Professor Susan Barr and I showed this in a diet diary study because premenopausal women, who didn't change weight across one cycle, who ovulated and made progesterone ate 300 calories more than those women who didn't ovulate.) Also, we recently completed a randomized placebo-controlled study in healthy menopausal women and the women on progesterone didn't change weight any differently than the women on placebo. They also didn't change in waist circumference. So progesterone will not make you gain weight, and it may even help you lose weight.

About increasing facial hair

Most of the progestins (ones that are used with estrogen in the birth control pill and in progestin-only pills) except medroxyprogesterone (also called Provera) are created from a testosterone chemical base! That's why there is a real concern about them and male hormone side effects like making more facial hair.

I have not formally tested facial hair and progesterone but I have lots of personal (I needed progesterone for intense perimenopausal and menopausalhot flushes and took it myself for seven years) and clinical experience with it. In addition, I have studied how it decreases facial hair because I used it to treat women with anovulatory androgen excess (AAE, also called PCOS) for whom increased facial and male pattern body hair are a big problem. I know it decreases facial hair from that experience—here's how it works: 1) It suppresses the pituitary hormone called luteinizing hormone (LH) that stimulates the theca (outer coat of the ovary) that normally makes male hormones during the menstrual cycle; and 2) it directly inhibits the production of dihydrotestosterone, the hormone that stimulates male-type hair growth by competing for the enzyme that converts it from testosterone. Therefore I'm sure that progesterone will not cause you to have increased facial hair.

The most common 'side effect' is increase in soundness of sleep, although not all women experience this. If a woman takes progesterone and goes to sleep and for some reason (like a full bladder) awakens her within four hours, she may feel dizzy or groggy.

Estrogen’s Storm Season: Stories of Perimenopause

by Dr. Jerilynn C Prior

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